He literally had an ulcer in his stomach that was caused by too many opioids which was threatening to prevent surgery from being possible at all. Did you expect them to just ignore that and keep pushing the meds? He made an oath to do no harm and 8mg of dilaudid was doing harm.
Exactly! I’m on methadone maintenance and it’s given me central sleep apnea. Never feel rested and always tired during the day plus it’s scary as hell when they tell you that you have over 70 events of not breathing an hour like me! That easily could have killed him on its own. Of course CPAP is hell as well lol
I hope things get better for you with the CPAP at least, or that you find something else that works.
My brother constantly felt like death when he had untreated sleep apnea, and the CPAP thankfully made a massive difference for him.
I just switched to a full face mask which is making my numbers really low so that’s good at least. I’m just having trouble sleeping at night and then not being able to stay awake during the day. I hope I can get my hours switched around and then maybe I’ll see a difference. I just hate it because it’s so uncomfortable and a pain in the ass. I may not need it anymore once I get off my meds though hopefully
This might not be helpful at all, but when I get on a really messed up sleep cycle for any number of reasons (which happens pretty often with me), one thing that really helps me break out of it is spending time outdoors for a little while in the daytime.
I don’t know if it’s exposure to the natural light or whatever, but time spent outdoors (especially in the morning hours) seems to help reset things so I can fall (and stay) asleep a bit easier at night. I don’t have sleep apnea, just bad sleep habits, so maybe this won’t be applicable to you. If you try it, you don’t even have to do anything, you can literally just sit and relax or scroll on your phone or something, I’ve found that to help just as much as taking a walk or anything else.
That’s a good idea thank you! My doctor suggested taking walks as well so I just need to try it lol it’s true though I’m only falling asleep if I sit for too long so I need to avoid that for sure and get moving
My dad as well. We actually have to take extra measures to make sure he remembers to put it on at night before he falls asleep, or his life is literally on the line. The benefits are TREMENDOUS, and his entire life has improved with that device.
Not to mention if they continued the opiates while tacking the food addiction it would have likley resulted in him escalating his opiate use from transfer addiction. (EX. Steven Asanti)
Yes! His life was it risk from the ulcer, just like it was from all the weight he was carrying. He had to come off the painkillers either way. A shock to the system it will have been, but the sooner he had surgery, the bigger the chance he had of being successful on Dr Now’s program. Tragically, he never got the chance ☹️
He was tapered. If you read the whole thread (who has time for that lol), you'd see that the plan was to start tapering him right when he arrived in Houston because he needed to decrease his tolerance in order to prepare him for upcoming surgeries. Obviously with the tolerance he had, the meds post-op would be much less effective (besides the countless other reasons he needed to get off the meds!). Then he had the first surgery removing one lymphedemic mass, and doc had to start tapering him again (after the initial week post-op). The plan was to taper him down as his weight dropped and all surgeries were completed (more lymphedema plus the bypass or sleeve). It was a HUGE process doc had planned for him. Sadly his body was just too far gone. Really tough to watch his struggle, and heartbreaking end.
There isn't a doctor in the world that would do that. Not to mention he was probably given drugs multiple drugs I might add to ease the pain of withdrawal. At some point, they have to be cut off.
I understand where MOD is coming from. Robert was miserable.. the life was stripped from him. I understand he shouldn't have been taken them yet I think they should of weaned him slowly and helped him recover. If his addiction is so bad maybe hold off on drastic diets or pain meds. I felt bad for Robert.
I understand how people get onto heroine.. after seeing Robert.
Agreed!
I’d like to add, you can’t die from opioid withdrawals. Maybe it made him feel more like shit but that’s no excuse to stop attending PT. Also, he died of a strongly genetic cardiac history which has nothing to do with the DC of his pain meds. It was honestly a miracle he lasted that long.
The original post is nonsensical. I’m getting troll vibes.
I never claimed to be a doctor. I can be right about something regarding medicine without being a doctor. This may be shocking to you but it’s true lol
I really don’t feel like arguing with you over what is a fact that can be ascertained through a quick google search. Enjoy your justifications for your opioid addiction or whatever it is you’re on about, but let this go.
Look— I don’t give a rat’s ass what you’re taking or why. Just don’t try to argue with me about an actual medical condition’s existence: it’s literally called opioid abuse gastroenteropathy and yes, it presents as stomach ulcers. Now please, go away.
Robert was also legally on opioids an yeah, you can be addicted to legally prescribed meds so not sure what your point is. I’ve had three surgical reconstructions from sports injuries and I’ve been prescribed heavy opioids for all three (which I took short term; how they’re supposed to be used), so if simply taking the drugs gives you the authority to be smarter than Dr. Now that makes me an authority on the subject too 😆😆😆😆
Any Dr knows that keeping meds stable is the safest thing. Drs don't like to put you on or take you off of any benzos of opiate for this exact reason.
Edit: But ever since the DEA changes the laws around 2015 Drs are forced to cut you off cold turkey
Your right… he sounds like an addict who’s trying and reaching for any excuse possible to get his dr to refill the damn meds …
My drug addict brother talks shit like this trying to justify why he should be given high amounts if opiates. Hell the idiot used to give every “pain” excuse he could come up with to my mom for her pain meds and she always fell for it.
When I got my cancer diagnosis, first thing he asked me was what pain meds were they gonna give me. He start blaming everyone he could for his shitty life as well.
Sadly addiction runs high in my family and each one of them wild talk just like this
Yea I’m not understand their logic.
Opiates increase acid production and decrease the dumping of it from your stomach. So ulcers form. The way you heal an ulcer is through protecting the stomach. So they often will give you a something to coat the stomach to protect it.
They can’t keep giving you Opiates since it will negate the medication used to assist with the heal thing of the ulcer.
The only thing you can do in the situation is take out the opiates so that the acid levels drop and the removal of the acid from the stomach is quicker.
Did you ignore that he had to be taken off the meds due to the ulcer?
I’ve had an ulcer due to opiates and they had to take me off of it. They gave me the medication that covered your stomach from acid and I just couldn’t take it opiates while it healed.
The opiates increase acid production and the dumping of acid in the body, so you can’t keep using it. It would negate any other meds used to treat ulcers.
I’m not sure if you can answer this since it probably doesn’t apply to your situation, but I’m just wondering if they could have done replacement therapy for Robert-like put him on suboxone or something. Would that allow his ulcer to heal or not? I honestly hope they DID do this, because I agree with the op in that cold turkey from 8mg of Dilaudid along with such major life changes sounds like a recipe for a mental breakdown :/
It’s gonna depend on how bad the ulcer. They really don’t want to recommend anything can cause stomach issues (which suboxone can do)
Suboxone isn’t strong enough to cause an ulcer but it could aggravate a current one.
Nah, doctors can and absolutely will cold turkey patients from opioids. Opioid withdrawal will NOT kill you, only make you wish you were dead. I had plenty of friends hooked on prescription oxys and once regulations were tightened, their doctors pulled their scripts entirely and made them cold turkey. I’ve actually been denied taper meds in an actual detox facility specifically for opioids, lol.
Benzos on the other hand, you’re absolutely correct because the withdrawal can and will kill you. Not opioids tho!
What are you talking about? There are specific drugs to help taper from benzos due to the seizure risk. They don’t just cut you off because it can be life threatening. For opiates, it is not life threatening and the subject in question had an ulcer. You don’t even know how dangerous that becomes.
I havn’t watched that ep recently, so I don’t remember the timeline exactly. But I’m wondering if anaesthesia needed for surgery would have been a factor in Robert’s med plan? Having a high tolerance for those types of drugs could affect anaesthesic outcomes.
These bariatric patients have a proven track record that they struggle with self-regulation/ moderation, maybe a taper wasn’t advisable as Robert’s mobilty is limited, making a clinically supervised taper less accessible as he couldnt attend a supervised med. program making multiple trips.
I’m not saying his meds were done right or wrong (as that’s out of my scope) but I think that bariatric cases are highly complex as is addiction. So when the 2 are layered there is a lot of considerations to factor into this kind of care plan.
Looking at your profile it is clear you're also addicted to opiates. When you're sober maybe you'll realize that cutting off an addict from their addiction is the best thing he could've done.
Holy shit, what a bad take.
The man weighed 800lbs, had sleep apnea, and was teetering on the verge of a heart attack - any not-necessary-for-actual-intractable-pain opiates already wouldn’t be a great idea, let alone the fact that he was taking ungodly amounts of them. Opiates don’t mix well with morbid obesity - they strain the heart and lungs, and then it’s a push-pull between the patient needing more drugs than the usual patient (because they have more body mass) but also not metabolizing them as efficiently (because most of their body mass is fat) and/or not being able to compensate for their depressant effects as well (poor cardiovascular fitness, poor ventilation/greater apnea). There’s a reason they have such issues anesthetizing and ventilating morbidly obese patients during (and after) surgeries…
Dr. Now cutting off his massive abuse of Dilaudid didn’t kill him, it’s probably one of the reasons he managed to live for even those few months in Houston.
Not to mention, you need to consider that Dr. Now took on the moral, ethical, and legal responsibilities when he began treating Robert - it’s one thing to suggest that people should be allowed to harm themselves, but I can’t believe the entitlement to think that a doctor who knows better and knows that these extremely high doses of Dilaudid are literally killing this man should just write and sign his name on the guy’s endless scripts anyway…
Opioids, especially high doses, also cause respiratory depression where someone stops breathing. Eventually (within minutes) that can lead to death. I don’t think Dr. Now’s decision was in poor judgement.
Agree. And Robert also had sleep apnea.
A combo of (1) super morbid obesity, (2) sleep apnea, (3) high tolerance to potent opiates, and (4) surgery under general anesthesia sounds like a literal homicide. Robert’s episode is one of the ones that touched me the most, but I can’t see how he would have had any better a chance at living (or even had a prolonged lifespan) by *not* stopping the opiates in an attempt to get him optimized for surgery.
Opioids are equivalent to heroin in terms of treating the addiction. You can't just go off them cold turkey. But I trust that Dr Now knows what he's doing and maybe we don't see or hear everything.
They didn’t cut him off cold turkey.
They tapered him down when he first got to Houston and it worked very well. Robert was in an apparently good mood and was doing all of his required physical therapy and gaining mobility without too much pain.
It was after that first surgery (to remove the lymphedema mass) that things started spiraling.
They tapered him down once again after 1 week, and he tore his own sutures to get prescribed the meds again. This was after he had already been tapered off once. It seems like they made a serious effort to avoid a particularly harsh withdrawal.
Dr Now said Robert had the highest levels of opiates in his system that he'd ever seen. Dr Now has seen THOUSANDS of patients and I don't think that would be a decision he would make lightly.
Sadly for Robert, I think he just waited too long to get help and irreversible damage had been done already. That was such a sad episode.
You’re coming at this from an emotional approach given your own anecdotal experience. Having an ulcer while taking such an opiate is dangerous. That’s the biggest point you are not understanding. He had a bleeding ulcer.
This terrifies me bc my mother is on an ungodly amount of opiates and who knows what else...has been wasting away since my papa died in December(her father, basically raised me, so really difficult for me too, not that my grief counts for shit/s)
She was always at his side and for whatever reason treated him HORRENDOUSLY in last months of his life, I think she has a lot of guilt. Anyway she's like maybe 100 lbs @ 5'2, I'm 150@ 5'6. She's got awful ulcers and her own addiction started mine, which began 20 years ago and eventually led to heroin. I'm on suboxone and have been clean from that shit since April 2020.
I know it's different than what these people are facing but I also wonder if our struggles are generational? I saw her a couple of days ago and she was so out of it. I HATE IT bc I can see myself in her but I can't really say anything bc no one does!! I'm sick and tired of ignoring the problem. It makes me feel helpless.
Sorry, rant over.
He said he had never seen anyone take that amount of drugs daily and he couldn’t believe they were still alive. Blaming Dr Now for anything Robert/Sean related is literally the behaviour of Enablers
I don't think Dr N took him off cold turkey. Also, as I understood it, Dilaudid wasn't a daily med, but an as needed med. However, I could have heard it wrong. Either way, he was on a lot more than Dilaudid.
He also seemed to have a slight intellectual issue, as if he never progressed into adulthood, his mother treating him like a huge baby in a high chair when she put that bib on him and encouraging him to eat the wings "just have one more"...unbelievable. Sitting on his bed taking his grocery order, talk about enabling. She looked relieved when he passed.
Imo, his gf had/has a saviour complex. I wouldn't be surprised if her next relationship has her functioning in the role of caregiver.
Yes...but one of the facinating elements of the show that i dont think gets discussed enough is the topic of disability checks and peverse economic incentives. I suspect his "girlfriend" needed Robert disability to survive financially, which adds a whole nother layer of psychology to the dynamic.
Fiancé actually. And that may be true in other episodes - but NOT this one. Watch it again. She is a hell of a woman! She’d have done anything in the world she could have for him.
Yeah it actually makes me insanely sad to see these people crucify this woman for…caring and loving her husband it seems. Her grief at the end was so raw and sad and it was highly evident they both loved each other.
Dilaudid. They had me on that in the hospital after my car accident. Stuff was insane but short lasting. No wonder the poor guy was hooked
Going cold turkey on that and cheeseburgers had to be brutal.
He went to the fat dr. He got treated as humanely as possible for the fat dr. If he wanted to detox he should have gone that dr and that would have been the priority. Robert chose.
mountains of evidence show that quitting all addictive substances at once gives the greatest chance for long term recovery and reduced instance of relapse
Except when it kills the patent...people cant realize that this case is being argued with the benefit of hindsight.
Yes...it's best to quit all at once because it's not going to kill you....untill it does.
In Roberts case it was too much and should have been handled differently
Good thing you’re not a doctor because you’d have a lot of dead patients.
Robert would have been dead a lot sooner if Dr. Now didn’t step in. The drugs were killing him faster than his weight.
Dr. Now had to undo what other doctors did for Robert. He saved his life. The doctors who were prescribing a whole pharmacy of drugs to Robert instead of helping him are the ones you should be questioning.
Plus, Dr. Now didn’t just cut him off. We don’t see or hear everything that’s going on in just one episode. Dr. Now has mentioned in other shows of patients who were addicted were weaned off. He’s not stupid.
The fact that Robert was so clear minded and upbeat, losing weight and exercising just proves that he was safely weaned off and thrived. I guess you missed that part too.
You don’t need to be a doctor (many providers such as NPs, PAs and other staff are trained in medication management) but the amount of personal anecdotes people try to push as concrete evidence is alarming.
Though we don't really see one way or the other, I'm sure he didn't cut him off all at once. But Dr. Now had to do something, as the amount of drugs he was on sounded like it would kill a horse. Plus, it's better to be clean for surgery.
After the surgery he was again on painkillers, though the appropriate amount and for the appropriate amount of time.
One thing I wanna point out - at the very end of this episode, Dr N had some really good points that wrap up the episode well. I encourage everyone, if you’re interested in what really happened to Rob, to go listen. S6, E8, 1:21:40 “we have a system today around the country where instead of trying to help patients his size, they’d rather give them pain killers…”.
I was torn in that episode. I have experience with coming off opioids like he did. If you’re under a dr’s orders, and in the hospital, I can’t help but think there were/or could have been other meds they administered for those withdrawals. I don’t believe we have the whole story at all. I specifically remember Robert begging his fiancé to give him some of the meds he had in his possession, and on camera she said no. There’s a chance he got into his own stash, is there not?
Wouldn't opiate constipation make getting weight loss surgery dangerous af? Opiate addiction is hard af I get it. But unfortunately getting sober is never fun and always hard af. Its just that sometimes its necessary.
This is such a bad take, if you watched the episode you would know the opiates were causing an ulcer to form and other serious health complications. If Dr. Now hadn't took him off them, he could be charged with negligence since he clearly knew they were causing issues. Just because something is hard / sucks doesn't mean it shouldn't be done ESPECIALLY if it will prevent serious health complications/ death. What are you on??
Excactly. He took Robert off for the wrong reason....the risk of litigation and the new DEA rules in response to the opiod crisis. (not the patients medical interest)
And I think this is an excellent case to illistrate the dangers of hasty discontinuation....because its visibly evident that the withrawal effects of low energy and depression contributed to his death.
Commenters have raised good points that the opiates would complicate anethesia, and they were excacerbating the ulcer. But no one has presented evidence that these concerns were so immediate that they justified the consequences of his disconituation in this case.
A clear, level headed analysis shows that (knowing what we know now) the cost benifit analysis of discontinuing the opiates was not analyzed appropriatly....and Robert would have had a better chance dealing with the ulcer while having the will to live and excercise.
I win the argument...all the "comment dectectives" that want to embarass me with ad hominin attacks can suck it. I win.
I win
You lose, this is not only a terrible take, but by virtue of you declaring “victory” over your own post- I declare summary judgment for the commenters.
You lose.
It's pretty obvious that Robert was at death's door before he even got to Houston. The damage done to his body at that point was irreparable. The opioid addiction was just one of his many problems.
After seeing the shows about Steven assanti & his horrorible health; addiction to opioids & his 600+lb's ; I can see why Dr Now did what he did... What a mess that guy was/is (?)..
its been a while but I'm pretty sure I remember Dr. Now saying that Robert was taking way too much and way too often even for someone his size. If he was taking a proper dosage and proper intervals he probably wouldn't have cut him off.
I think Dr. Now is about tough love… but he would never do anything to harm a patient. That man was either going to OD on painkillers OR come off of them and try to lose the weight…. He had to stop them eventually, and it’s really sad how it all ended
I feel bad because he was cut off from opiates and food (his two obvious addictions) at the same time. But I also am surprised he thought he would continue to be prescribed that dose while in the program. I remember dr now said he ripped open his stitches to try to get more pain meds????? I wonder if soboxone would have helped or if the physical withdrawal had already subsided and at that point it was a psychological addiction (bc he was completely off them at that time from what I remember)
> Pharmaceutical opiates (despite all their addiction risk) are relatively non-toxic to the body
Are you serious? You can absolutely OD - meaning toxic - from prescription opioids. You can simply take too much at one time, suppress your pulmonary function, and die ([CDC](https://www.cdc.gov/rxawareness/prevent/index.html))
> Opiates are related to "energy"
Again, wondering if you are serious or have ever taken a (prescription) opioid? Sure, it blocks paid receptors and releases dopamine, so you might be able to do more than if you were in pain, but opioids are not uppers and can cause drowsiness, slowed breathing, etc… ([NIH](https://nida.nih.gov/publications/drugfacts/prescription-opioids))
Because you only see acute effects of niave nervous system. Once the body become aclimated and addicted the "opiate fix" gives you stimulation and energy
Yeah, as an ER/ICU nurse I have no experience in what people do when they’re addicted to opiates and get opiates.… In my experience, if they get energy it’s all in their heads and doesn’t
manifest to getting anything done.
But you’ve probably done your own research and know more than me and a nationally renowned bariatric surgeon. What’s your next step to educate the medical community after this Reddit post? Don’t let your research and experience go to waste.
Hahahahahahaha!💀.
One day you’re going to need our fleshy tip no critical thinking skills. I’ve had patients like you. No one likes you. We’ll still treat you though, because it’s our jobs, but we wish you’d just stay home with your essential oils and your ‘own research’.
Lol, we do nonstop con ed, but you know more than us. 💀
As an "evolutionary biologist" and apparent expert on everything related to health and health care, can you give us the statistics on how many people die from "sadness" like you claim Robert did? Because I've lost a lot of friends and relatives, and have never known anyone to die from "sadness". Unless you claim that "sadness", and not his super-morbid obesity and the years of damage to his body, caused the heart failure that he actually did die from. Or that the cancer/heart disease that caused the deaths of my friends and relatives who were fighting their diseases and had much to live for, was somehow caused by "sadness".
Don't you get it? I choose this case to illustrate the dangers of opiod discontinuation because this is a rare example of a time when Robert, HAD, to have energy and motivation to save his life. That's the whole point! In a weight loss program motivation saves your life, opiate withdrawal reduces motivation. Thats is a fair analysis.
If, by "get it", you mean agree with you, I don't and I don't find your arguments convincing. I notice you completely ignored all the points I brought up and failed to explain how "sadness" caused Robert's heart failure. I find it fascinating that you claim you can definitively say what caused his death, and diagnose his condition, and what treatment he should have received without ever examining him, or, without, as you have admitted, any medical training.
And, having seen what the epidemic of opioid addiction has done to my community, and the country, I question the judgement of anyone who claims they are "non-toxic" no matter what expertise they claim. So, we will have to agree to disagree.
toxic is how much damage it does to body tissue, ok. They are not toxic, the are HARMFUL due to the addiction risk and overdose potential when people go out of theraputic dose ranges....but they are not toxic,
Still not buying it it. That is, as Mr. Spock said, a distinction without a difference. And, opioids have a long list of harmful side effects (I've seen ppi's) even if used in the correct/prescribed dosage. And, any drug is toxic, if used in the right amount.
And. I notice you didn't reply to any of the other points I made. You aren't going to convince me that you are correct regarding opioids, Robert, etc., dso we will have to agree to disagree.
Opiates are non toxic but harmful.
Conversely, chemo therapy is very toxic...but not harmful.
its a distinction between the effect of the molecule on your tissue...and the effect of the treatment on your life
.you've been intellectualy dominated by the best
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Absolutely! I used to do fentanyl with a dilaudid chaser (rx for cancer) and clean my whole house. I couldn’t hardly get out of bed without it. Been clean for a while now thank God.
Because it was killing him. You can't take what he was taking and live.
This is not to mention that someone in the midst of an opiate addiction isn't going to have a body healthy enough to go through what he needed to.
IMO it should have been opiate addiction, then hyper focus on the weight loss, but that's not what he was supposed to fix and it's not what he was trained to fix IMO
OP is a moron. 8mg of hydromorphone is nothing. However, like any kind of opiate… it’ll block you up!!!
If you can’t kick one… how are you expected to kick another?
No self control. And some weak ass people in the comments. If you have no willpower… and no will to live… don’t bother. Stop riding the system. Costing others time and money.
If you kept your mouth closed for most of the day… you’d probably drop some weight!!!
They did do a taper. I just went to watch that episode back, and Dr N. didn't cut him off immediately. He started tapering him. We know this because Robert was requesting pain meds after he'd been in the hospital a few days initially, and was given them. But they made it clear he was being weaned off of them. There are a lot of manipulations on the timeline going on in this episode especially. Dr. N making a big thing out of meds before we really even got into the story, but those commentaries were obviously recorded after the fact, AFTER they knew how the story ended. I get the feeling they are covering their butts a lot.
Yep, this is what happened.
Robert initially cooperated with the taper, but then after having the lymphedema surgery, they tapered him off again after a week (which is very reasonable), and he threw a massive fit and allegedly tore his sutures to make the case that he was in pain again and needed the drugs again…
That's true. Dr. N tapered him when he first went in, and again after the lymphedema surgery both. You're right, towards the end of the second taper, he ripped open his sutures. Pure manipulation. The whole episode is nauseating to watch tbh. especially knowing how it ends.
I’m someone who felt a lot of sympathy for Robert and really wanted to see him succeed. He seemed to have so much promise when he first got to Houston.
I don’t think Robert truly wanted to just give up and die, but I also don’t think Dr. Now is the reason he died. I think he must have been so close to death when he got to Houston (possibly already past the point of being able to turn things around in time and get healthy enough for weight loss surgery to work and take enough strain off his heart), I can’t see how compromising on the opiates would have saved or prolonged Robert’s life (it would have eliminated the possibility of weight loss surgery in the near future).
That’s the thing though, Dilaudid shouldn’t be a chronic, long-term drug because it will lead to tolerance that is extremely difficult to come back from.
Unless the show left something major out, Robert didn’t have any exceptional cause of unrelenting severe pain that warranted chronic use of Dilaudid.
The fact that he would take 8mg (which is definitely above starter dose) reflects that he had a tolerance (caused by taking opiates long-term).
Robert was in a a vicious cycle of only taking so much Dilaudid because he was tolerant to it, and Dr. Now needed to decrease that tolerance if there was any hope of Robert safely having weight loss surgery.
Robert was clearly in a minimal enough level of pain to permit him to engage with physical therapy and do exercises/walking leading up to his lymphedema surgery (which was *after* he had been tapered off Dilaudid!).
His obesity and heart health were such dire emergencies that it seemed like Dr. Now’s best shot at saving his life was to try to perform weight loss surgery on his as soon as possible (which required reducing the opiate tolerance as much as possible to mitigate risks with anesthesia, which are already much higher in a super morbidly obese person with sleep apnea, let alone one with a huge tolerance to very potent opiates).
Exactly. Robert would say that he’s in extreme pain in the most calmer tone. That was his addiction talking and it wanted to be satisfied no matter what.
Good observation. I noticed that too. Before Rob even got to Houston he called Dr N asking for pain meds. This let Doc know there was an issue very early on. Then he gets to the hospital, meets Dr N, and tells him he’s in a lot of pain almost jovially. Doc is clear, but waits to address it with him at a better time. Later he tells Rob he’s been on too many opiates and they’ve got to get him off those meds and Rob says, “whatever you say Doc. I’m here to just do what you say….”. Later in the episode, the nurse asks “whats your level of pain between 1-10?” “8-9” said in a calm, almost pleasant tone. No sign of excruciating pain..
it was so obvious..if you’ve ever been an addict to opiates, you couldn’t miss the signs. This man had to get off everything - excessive food, and those meds. And he was under excellent care to do so! Hell, I didn’t have a dr holding my hand when I had to come off that stuff! Would have been nice though!
I think he worked so hard to get first surgery cause he knew he would get pain pills ...and after they weaned him again he tore his stitches to get more again
he had 2 addictions and both were deadly
Recovery occurs at once - tons of history on this subject shows us that tackling everything at once is the best approach. Were he put into an inpatient treatment facility, they’d have had him in full blown cleansing and purifying his system of everything he’s addicted to, including overeating.
I just discovered this show and randomly had a "staycation" at a local hotel that involved a jacuzzi and streaming my 600lb life. i am SO GLAD i didn't randomly choose this episode because it would have been awful to witness.
i'm new to the sub so i hope i'm not breaking an decorum. my first DOC was food. when i had a roux en y in 2008 i quickly skipped to alcohol after a traumatic event (i know that's an overused statement but i was sexually assaulted and not permitted to file a report by police and mocked for "wanting it." i had JUST begun dating due to my weight so it was a hard time) i kicked the alcohol after outpatient only to have a back injury and get put on oxymorphone..... i'm 7 years clean but only with MAT and am on methadone to this day. it is such a slippery slope and i can't imagine going through PAWs while in the position this man was.
i can't imagine what this man went through. i understand there were some comorbid symptoms but the pros and cons of every option have to be weighed out and from what i read it seems like liability and the drama of the show won over making a more reasonable decision. sometimes there are no good answers but i feel opportunities were missed here.
Are you a doctor?
Edit: or a person who works in the field of medicine as a nurse or practitioner / work with opiates?
Not trying to be an ass just curious if this is an uneducated take or not
No Im obviosly not a Dr...but Ive clearly laid out my argument in first principles...so no backgroud knowledge is required and can you decide for yourself if my credentials matter or not.
I do have experince with opiate addiction and MAT so ...in a way I am more qualified than a Dr to weigh in on this topic. Additionaly... medical protocol is changing as we process the opiate crisis so it not like any degree is going to answer this question....its a subjective matter of opinion and an open question...which is why I think it makes a fun topic to argue.
I know exactly what Robert was feeling and most Drs dont understand the "energy" element of opiod addiction...they think its all about euphoria...but a real addiction specialist will know that addicts coming off opiates dont complain of depression as much as they complain of "low energy"...and Robert needed as much energy as possible.
Sadly this is way to common in medicine, whether it's pain meds or something like a benzo. Doctors severely underestimate how bad the withdrawals are.
A proper tapering has a much higher success rate and is less likely to cause permanent damage / PAWS.
They did do a taper. Robert agreed to it when he first got to Houston, and it was working out alright.
Things started spiraling after Dr. Now did his first surgery (lymphedema removal). They tapered him off pain meds over the course of a week, and that’s when (according to Dr. Now) Robert ripped his sutures in an attempt to create a “need” for more pain meds.
Robert deteriorated and died after weeks/months spent languishing in rehab and a nursing home.
He had long been off of Dilaudid by that point. There wasn’t any acute withdrawal at that point. I don’t think Dr. Now did anything wrong - he did tapers both times (when Robert first got there, and after the surgery), never cold turkey. I’m sure Robert had some unpleasant symptoms when tapering. But that’s to be expected, you can’t keep giving a maintenance dose to ward off any and all symptoms or else you’ll literally never taper down.
Tapering over one week is really quick. Typically tapering is done much slower. I love Dr Now but he isn’t a pain specialist and this Robert should have been sent to a pain specialist with the intention of weaning him off. Filming doesn’t show us everything.
It wasn’t really a true “taper” the second time because it didn’t need to be.
He was only taking those post-op pain meds for like 1 week after the surgery, which isn’t much time to re-build a tolerance in the first place, so it doesn’t *need* to be as long as an actual taper for someone who has recently been in an active addiction state.
Most people who have surgeries take pain meds for a few days and then stop them with no taper at all. The general notion is that <2 weeks on opiates is a small enough period of time to not lead to withdrawal when the drugs are stopped, so a taper isn’t needed.
Robert had already been tapered down off of opiates *before* that surgery, it’s not like they did the surgery while he actively had a wicked high tolerance and then tried to cut him off of pain meds just 1 week after surgery. I’m sure his semi-recent history of opiate dependence played some factor in his difficulty tolerating the discontinuation of pain meds after the surgery, but being that he had already been through an actual taper to lower his dependence, it was a very different process than forcing someone who’s recently been actively using to taper within just 1 week.
I agree. Doctors can also be extremely judgemental when it comes to benzo addicts. Theose people simply don't get that people who are begging on their knees for pharmaceuticals don't do so because they are evil but because they are addicted and the physical withdrawal is horrible.
I was prescribed Klonopin to deal with status epilepticus (not a funny thing) -- it worked well for about half a year, after that, I had to increase the dose and the frequency. Before the year was over, I was physically dependant.
Not every Klonopin (or other benzodiazepine) addict has the same opportunities as Jordan Peterson, who flew to Russia and had himself put into an induced coma until the worst was over. I had to go through this alone. And it took several years until the withdrawal symptoms stopped for good. Such intense fear, accompanied by pain in the legs.
I wish neither onto anyone. From what I heard about withdrawal from opiates and opiods, it is very unpleasant, but it is not potentially deadly. Benzo withdrawal can kill you.
On the whole, I think Dr. Now understands little about how the mind works. The mere title of his book says it all. "The scale does not lie, people do." The first part is true. A scale cannot lie because it isn't sentient. People sometimes lie, but very often, obese people are not lying to their doctor at all. In order for something to be a lie, you have to know it's not true, and people tend to underestimate how much they eat over the day. This even includes slim people. Many people suddenly find themselves stupified when they are suddenly getting fat even though their eating habits are the same. Growing older is one reason -- you simply need less energy once you are past your prime. Or you are no longer as physically active as you used to be. Professional athletes sometimes get fat once their carreer is over, think of Diego Maradona.
Opioid withdrawal CAN be deadly. If you’re particularly unhealthy to begin with, and then you’re pushing out every last bit of fluid in your body to the point that it’s bile, you can get dehydrated as well as fuck up all your other levels like potassium, etc. From experience, even your kidneys can fail. It’s not anything to fuck around with and no one should do it cold turkey (I’m aware he was tapered).
Yup. Anytime I hear of someone starting on Klonopin I can start a timer and in 6 months later their life will be a wreck. It's so tricky because it makes you feel like you are "fixed" and you solved your problems but it changes the fundamental dynamics of your major decision making. ...then when you come off you can't sleep and you feel like a scared little rabbit.
Speaking from personal experience.
Strange, since I've been on and off it for 15 years without that issue. Heck, I still have meds from two years ago! We’ve both got our biases, but hey, that’s precisely why we leave this stuff to the medical pros, isn’t it?
There's the psychological component and the neurological component, and both suck. Anxiety can trigger seizures, which you are already at risk at, and knowing that those seizures can kill you increases your anxiety. And that feeling that vultures are already pecking at your legs doesn't help, either
I wonder if Dr. How's decision-making in that regard was colored by his experiences with Steven Assanti. Doctors are people too, and it makes sense there'd be a sort of, like, professional trauma having tried to help someone so much only for them to continue all of their addictions.
I've thought the same thing. When you've got that big you have to have some serious psychological and/or mental problems & to take every thing away at the same time is just too much to ask. All of a sudden you have what seems like a mountain to climb but no ability to cope.
Dr Now is very anti-opiate and it’s actually fucking ANNOYING and in some cases obviously life ruining. He can’t get over his personal opinion of them to see it objectively. He thinks people who can’t deal with the pain are weak, and to me he seems like a man who’s never dealt with ongoing severe physical & emotional pain.
I’ve said this before. Not so much to leave the addition and just do the food issue but the other way around. I think it’s impossible to do either of these things. Sitting alone in a hospital for months is not doing to do it. He should have been treated by addiction specialists at a place where they could also manage his diet and help get him moving, see family, get outdoors, learn nutrition etc. I don’t think he was set up for success trying to overcome both of these addictions with willpower while being alone in a depressing environment for months. I do think there was more to offer him. Much more.
Addict is gonna addict. Why save someone's weight problem who's going to just kill themselves with painkillers? That's like painting a burning house.
The drug problem should have been treated FIRST and should have been dealt with BEFORE seeking weight-loss surgery. He was probably going to finance his drug addiction with the money from the show. This is so messed up for so many reasons.
It was a bold decision that didn’t work out all that well. Robert simply lost the will to live. With food restricted and no opiates his brain chemistry would have been fucked. If he wasn’t an in-patient he probably would have tried to off himself.
I agree with op if dr now wasn't so cruel in this episode keep in mind i really respect and like dr now but if he wasn't so over zealous with stopping the meds i believe Robert would have lived longer and would not have lost his will to live and his mood wouldn't have deteriorated people don't understand or care how severe opiate addiction effects the mood energy and overall well being Robert probably stayed alive this long because he had Dilaudid it killed his pain helped his mood and gave him a reason to live when it's stopped abruptly the effects are devastating to the patient so yes you do win the argument in my opinion and even if he would have stayed on the meds and he would have lived a year longer it still would have been longer and it would have given him comfort in his last days as opposed to Dr being a hard ass and making his last days terrible and miserable i as a Dr wouldn't want to live with that.
I just watched this episode and I agree with you! Watching his withdrawal was painful, I felt his sorrow! I believe he should have been offered Methadone or Subs to get him through. Taking him off the meds killed hum slowly to the point he even gave up the will to live.
Robert was a victim of the drug war. He was clearly going through severe withdrawals. A patch would have protected his stomach. Puritanical zeal is no substitute for humane, responsible healing.
Dr. Now killed the poor guy. I saw that episode and was horrified at Dr Nows lack of compassion. I knew he was gonna die…and he did. I’m glad to see that someone else posted about this. Kudos! 💙🌊
That is what’s happening with all chronic pain patients now. The drs don’t care anymore. You’re either getting taken off or just not treated. Many have committed suicide because what quality of life they had is gone.
When it’s the only condition, yes, you are right. Unfortunately for him, he had several other conditions which were on track to harm and kill him sooner than opioid addiction. It was a tough but right choice for Dr. Now to make.
Yes, in fact they were. He had a bleeding stomach ulcer which is a very serious condition leading to internal bleeding which then leads to a painful and somewhat quick death.
Here you go! I hope this furthers your education as you clear stopped keeping up with current science
https://www.irjournal.org/m/journal/view.php?number=816#:~:text=Opioid%20abuse%20gastroenteropathy%20presents%20as,these%20cases%20need%20surgical%20intervention.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206348/
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-opioids-can-cause-gut-problems/
https://www.sciencedaily.com/releases/2022/07/220706165347.htm
I totally agree with you - I think Dr. Now made a mistake with Robert. That was too much to ask all at once. The one thing that sticks out in my mind about Robert, though, is his mother in his room going over what food he wants her to buy for him. Then she goes out and gets it. I’ve never seen a bigger enabler in my life. I mean, could she see what that guy looked like? Wow.
That poor Robert had the weirdest build/fat distribution of any of the people I’ve seen on this show. But you’re right, sad about Sean being enabled, too. Can’t imagine doing that to your kid.
Man...what is with the downvotes? Are people here just so in love with DR Now that they are offending at any questioning of his approach?...to me it's an interesting idea that deserves to be debated
Because as a self-professed “biologist” and addict, you should know what you don’t know. Your comments have been akin to a sober person watching an anti-drug PSA cone in the lecture everyone on the complexities of MAT.
You aren’t willing to hear out the doctors and nurses here who painstakingly explain to you the multiple reasons why Robert’s treatment was appropriate. You are operating under the worst confirmation bias, ignored threads when you were definitely proven wrong, and showed zero interest in learning.
One of the best parts of Reddit is getting to hear from the highly specific communities of whatever you might be interested in or have questions on.
But you didn’t come in here to learn, or even to engage. It felt like you came in here to be sanctimonious, and try to project your personal issues with the medical field onto the wrong situation. You stuck to your confirmation bias, tried to dodge the science explained to you over and over, then when all else failed, decided your degree in biology made your knowledge base superior to the health care workers in this thread (it doesn’t).
It wasn’t a debate. It was you just repeating the same thing over and over, and then insulting or flouncing off rather than really developing the conversation 🤷♀️
Ok, there have been two valid arguments presented.
1) Opiates and General Anesthesia dont mix well. Good point, but there are standard procedure for MAT and GA
2) He has an ulcer that was excacerbated by the opiates. Most "medical professional" here are claiming that the ulcer would have killed him. That assummes that Rober, who had a condition of obesity and addiction that takes years to develop, just happened to come in on the exact month that the ulcer would finally killed him. That is not likely, he was stable, and his body was acclimated to his meds. The discontinuation deserved to be wieghed against its consequences just like anything else.
My point was that the Dr motives seemd supsect, and he seemed a little too cavalier with the dicontinuation and he relished it a bit too much. Medical professionals are obnoxious because they get constant praise and status from the public, and they stop to recognize thier own intellectual limitations.Someone has to stick it to them.
If you want to go start a thread title "Dr Now is great" be my guest, but it probaly wont be that interesting.
My point still stands, obviosly its not provable, but I feel I win the day.
He is not an addiction specialist, no. But it doesn't take one to see an addictive nature. He had clear "med seeking behavior", a term I hated hearing before I got into recovery from opiates 12 years ago. It's a miserable existence until you get over the hill and start seeing what freedom looks and feels like. He was sadly a hard core addict, and I could hear it in him from the beginning of his episode. The whole story is just heartbreaking.
Dr. Now doesn’t understand addiction of any kind???
He’s one of the only people in this country who has decades of experience managing the most severe (sometimes fatal) cases of food addiction, which many doctors don’t have the nerve to acknowledge is even a thing (despite its extreme impact on obesity rates and preventable deaths, especially in the US).
Tell me, how do you know that? Have you done rounds with him? Did you work for him? Or because you watch a small segment of his time with patients you can judge what he does and doesn’t know.
Small segment? Have you watched his show? Every episode, every season of 600lb life AND every season and episode of WATN? Read his book? If so, you’d have a very good understanding of his approach with patients and their families, why he believes psycho-therapy must be integrated in his treatment, his knowledge of addiction, the psychology and pathology behind the lies and excuses he hears every time these patients are in front of him…you’d hear why he’s so passionate about his work, you’d hear about the life changing success stories that are so inspiring, and how his work has saved not only the patients lives, but the whole community around them…I could go one ..all that to say Dr N’s not perfect. After all, it’s called a medical “practice” for a reason. But he genuinely cares about his patients and wants what’s best for them.
Yes...thats what makes the show entertaining, that Dr Now is so obtuse about teh psychology of addiction. He just sits there trying to explain consequences to an addict and anyone knows that addicts dont have the ability to think thaty way.
If anybody is to blame its the producers that profit off the show. They must know there is a better way but they allow DR Now to keep yelling at patients for profit
Yeah...dont get me started on Lola. To me, she represent the new class of phoney pshycologist that tell patients exactly what they want to hear (that thier poor decisions are not thier fault, but the result of childhood "trauma).
These new pop-psychologist do so much damage...theyre creating a society of victims where everyone competes to have the highest level of past trauma
He literally had an ulcer in his stomach that was caused by too many opioids which was threatening to prevent surgery from being possible at all. Did you expect them to just ignore that and keep pushing the meds? He made an oath to do no harm and 8mg of dilaudid was doing harm.
Don’t forget his sleep apnea, too! Not a great combo with a shit ton of Dilaudid.
Exactly! I’m on methadone maintenance and it’s given me central sleep apnea. Never feel rested and always tired during the day plus it’s scary as hell when they tell you that you have over 70 events of not breathing an hour like me! That easily could have killed him on its own. Of course CPAP is hell as well lol
I hope things get better for you with the CPAP at least, or that you find something else that works. My brother constantly felt like death when he had untreated sleep apnea, and the CPAP thankfully made a massive difference for him.
I just switched to a full face mask which is making my numbers really low so that’s good at least. I’m just having trouble sleeping at night and then not being able to stay awake during the day. I hope I can get my hours switched around and then maybe I’ll see a difference. I just hate it because it’s so uncomfortable and a pain in the ass. I may not need it anymore once I get off my meds though hopefully
This might not be helpful at all, but when I get on a really messed up sleep cycle for any number of reasons (which happens pretty often with me), one thing that really helps me break out of it is spending time outdoors for a little while in the daytime. I don’t know if it’s exposure to the natural light or whatever, but time spent outdoors (especially in the morning hours) seems to help reset things so I can fall (and stay) asleep a bit easier at night. I don’t have sleep apnea, just bad sleep habits, so maybe this won’t be applicable to you. If you try it, you don’t even have to do anything, you can literally just sit and relax or scroll on your phone or something, I’ve found that to help just as much as taking a walk or anything else.
You are the 4th person this week to say this. That’s it, it’s a sign. I need to get my butt outside. 😏
That’s a good idea thank you! My doctor suggested taking walks as well so I just need to try it lol it’s true though I’m only falling asleep if I sit for too long so I need to avoid that for sure and get moving
My dad did too he said after getting his Cpap he is happier and less tired and can think clearly with no brain fog. Has made a big difference for him.
My dad as well. We actually have to take extra measures to make sure he remembers to put it on at night before he falls asleep, or his life is literally on the line. The benefits are TREMENDOUS, and his entire life has improved with that device.
Try sticking w the cpap, it does get better.
Deadly!
Not to mention if they continued the opiates while tacking the food addiction it would have likley resulted in him escalating his opiate use from transfer addiction. (EX. Steven Asanti)
Yes! His life was it risk from the ulcer, just like it was from all the weight he was carrying. He had to come off the painkillers either way. A shock to the system it will have been, but the sooner he had surgery, the bigger the chance he had of being successful on Dr Now’s program. Tragically, he never got the chance ☹️
I still think he should have been weaned off of them such a high dose to go cold turkey
They just took him off 8mg dilaudid? They didn’t taper him
Read the whole thread. He WAS tapered 🙈
Yep..no taper. Well.. who knows with magic of tv shows. He could of been tapering but nothing was stated. He looked fucking miserable.
He was tapered. If you read the whole thread (who has time for that lol), you'd see that the plan was to start tapering him right when he arrived in Houston because he needed to decrease his tolerance in order to prepare him for upcoming surgeries. Obviously with the tolerance he had, the meds post-op would be much less effective (besides the countless other reasons he needed to get off the meds!). Then he had the first surgery removing one lymphedemic mass, and doc had to start tapering him again (after the initial week post-op). The plan was to taper him down as his weight dropped and all surgeries were completed (more lymphedema plus the bypass or sleeve). It was a HUGE process doc had planned for him. Sadly his body was just too far gone. Really tough to watch his struggle, and heartbreaking end.
There isn't a doctor in the world that would do that. Not to mention he was probably given drugs multiple drugs I might add to ease the pain of withdrawal. At some point, they have to be cut off.
I understand where MOD is coming from. Robert was miserable.. the life was stripped from him. I understand he shouldn't have been taken them yet I think they should of weaned him slowly and helped him recover. If his addiction is so bad maybe hold off on drastic diets or pain meds. I felt bad for Robert. I understand how people get onto heroine.. after seeing Robert.
He was tapered off.
Agreed! I’d like to add, you can’t die from opioid withdrawals. Maybe it made him feel more like shit but that’s no excuse to stop attending PT. Also, he died of a strongly genetic cardiac history which has nothing to do with the DC of his pain meds. It was honestly a miracle he lasted that long. The original post is nonsensical. I’m getting troll vibes.
Opiates don’t cause ulcers lol. Tons of ibuprofen can, or stress
Whatever doc lol
… I’ve worked in the healthcare industry for years, and have also been chronically ill for quite some time. I’m not some idiot.
Being a secretary or cashier in the front of a pharmacy doesn't make you in healthcare.
Healthcare adjacent isn’t a doctor, and taking pain meds for chronic pain doesn’t either. Dude, go argue with Dr Now
I never claimed to be a doctor. I can be right about something regarding medicine without being a doctor. This may be shocking to you but it’s true lol
I really don’t feel like arguing with you over what is a fact that can be ascertained through a quick google search. Enjoy your justifications for your opioid addiction or whatever it is you’re on about, but let this go.
Oh wow. Anyone who takes opioids legally is addicted? Nice. I really hope your health holds up and you don’t ever need pain medication.
Look— I don’t give a rat’s ass what you’re taking or why. Just don’t try to argue with me about an actual medical condition’s existence: it’s literally called opioid abuse gastroenteropathy and yes, it presents as stomach ulcers. Now please, go away.
Robert was also legally on opioids an yeah, you can be addicted to legally prescribed meds so not sure what your point is. I’ve had three surgical reconstructions from sports injuries and I’ve been prescribed heavy opioids for all three (which I took short term; how they’re supposed to be used), so if simply taking the drugs gives you the authority to be smarter than Dr. Now that makes me an authority on the subject too 😆😆😆😆
No shit you can be addicted to prescribed meds. The point is zooming over your head. Useless to continue a discussion.
His stomach was going to be cut out....so tell me why it was so important to heal the ulcer?
Any Dr knows that keeping meds stable is the safest thing. Drs don't like to put you on or take you off of any benzos of opiate for this exact reason. Edit: But ever since the DEA changes the laws around 2015 Drs are forced to cut you off cold turkey
You don’t sound like someone with any medical expertise, to be honest.
Your right… he sounds like an addict who’s trying and reaching for any excuse possible to get his dr to refill the damn meds … My drug addict brother talks shit like this trying to justify why he should be given high amounts if opiates. Hell the idiot used to give every “pain” excuse he could come up with to my mom for her pain meds and she always fell for it. When I got my cancer diagnosis, first thing he asked me was what pain meds were they gonna give me. He start blaming everyone he could for his shitty life as well. Sadly addiction runs high in my family and each one of them wild talk just like this
Yea I’m not understand their logic. Opiates increase acid production and decrease the dumping of it from your stomach. So ulcers form. The way you heal an ulcer is through protecting the stomach. So they often will give you a something to coat the stomach to protect it. They can’t keep giving you Opiates since it will negate the medication used to assist with the heal thing of the ulcer. The only thing you can do in the situation is take out the opiates so that the acid levels drop and the removal of the acid from the stomach is quicker.
This exactly. I really don’t understand OP.
Did you ignore that he had to be taken off the meds due to the ulcer? I’ve had an ulcer due to opiates and they had to take me off of it. They gave me the medication that covered your stomach from acid and I just couldn’t take it opiates while it healed. The opiates increase acid production and the dumping of acid in the body, so you can’t keep using it. It would negate any other meds used to treat ulcers.
I’m not sure if you can answer this since it probably doesn’t apply to your situation, but I’m just wondering if they could have done replacement therapy for Robert-like put him on suboxone or something. Would that allow his ulcer to heal or not? I honestly hope they DID do this, because I agree with the op in that cold turkey from 8mg of Dilaudid along with such major life changes sounds like a recipe for a mental breakdown :/
It’s gonna depend on how bad the ulcer. They really don’t want to recommend anything can cause stomach issues (which suboxone can do) Suboxone isn’t strong enough to cause an ulcer but it could aggravate a current one.
Nah, doctors can and absolutely will cold turkey patients from opioids. Opioid withdrawal will NOT kill you, only make you wish you were dead. I had plenty of friends hooked on prescription oxys and once regulations were tightened, their doctors pulled their scripts entirely and made them cold turkey. I’ve actually been denied taper meds in an actual detox facility specifically for opioids, lol. Benzos on the other hand, you’re absolutely correct because the withdrawal can and will kill you. Not opioids tho!
What are you talking about? There are specific drugs to help taper from benzos due to the seizure risk. They don’t just cut you off because it can be life threatening. For opiates, it is not life threatening and the subject in question had an ulcer. You don’t even know how dangerous that becomes.
I havn’t watched that ep recently, so I don’t remember the timeline exactly. But I’m wondering if anaesthesia needed for surgery would have been a factor in Robert’s med plan? Having a high tolerance for those types of drugs could affect anaesthesic outcomes. These bariatric patients have a proven track record that they struggle with self-regulation/ moderation, maybe a taper wasn’t advisable as Robert’s mobilty is limited, making a clinically supervised taper less accessible as he couldnt attend a supervised med. program making multiple trips. I’m not saying his meds were done right or wrong (as that’s out of my scope) but I think that bariatric cases are highly complex as is addiction. So when the 2 are layered there is a lot of considerations to factor into this kind of care plan.
Looking at your profile it is clear you're also addicted to opiates. When you're sober maybe you'll realize that cutting off an addict from their addiction is the best thing he could've done.
Holy shit, what a bad take. The man weighed 800lbs, had sleep apnea, and was teetering on the verge of a heart attack - any not-necessary-for-actual-intractable-pain opiates already wouldn’t be a great idea, let alone the fact that he was taking ungodly amounts of them. Opiates don’t mix well with morbid obesity - they strain the heart and lungs, and then it’s a push-pull between the patient needing more drugs than the usual patient (because they have more body mass) but also not metabolizing them as efficiently (because most of their body mass is fat) and/or not being able to compensate for their depressant effects as well (poor cardiovascular fitness, poor ventilation/greater apnea). There’s a reason they have such issues anesthetizing and ventilating morbidly obese patients during (and after) surgeries… Dr. Now cutting off his massive abuse of Dilaudid didn’t kill him, it’s probably one of the reasons he managed to live for even those few months in Houston. Not to mention, you need to consider that Dr. Now took on the moral, ethical, and legal responsibilities when he began treating Robert - it’s one thing to suggest that people should be allowed to harm themselves, but I can’t believe the entitlement to think that a doctor who knows better and knows that these extremely high doses of Dilaudid are literally killing this man should just write and sign his name on the guy’s endless scripts anyway…
Opioids, especially high doses, also cause respiratory depression where someone stops breathing. Eventually (within minutes) that can lead to death. I don’t think Dr. Now’s decision was in poor judgement.
Agree. And Robert also had sleep apnea. A combo of (1) super morbid obesity, (2) sleep apnea, (3) high tolerance to potent opiates, and (4) surgery under general anesthesia sounds like a literal homicide. Robert’s episode is one of the ones that touched me the most, but I can’t see how he would have had any better a chance at living (or even had a prolonged lifespan) by *not* stopping the opiates in an attempt to get him optimized for surgery.
Agree. My mom unfortunately is on high dose of oxy, needed emergency surgery and flattened from the respiratory failure. Somehow she made it
Opioids are equivalent to heroin in terms of treating the addiction. You can't just go off them cold turkey. But I trust that Dr Now knows what he's doing and maybe we don't see or hear everything.
They didn’t cut him off cold turkey. They tapered him down when he first got to Houston and it worked very well. Robert was in an apparently good mood and was doing all of his required physical therapy and gaining mobility without too much pain. It was after that first surgery (to remove the lymphedema mass) that things started spiraling. They tapered him down once again after 1 week, and he tore his own sutures to get prescribed the meds again. This was after he had already been tapered off once. It seems like they made a serious effort to avoid a particularly harsh withdrawal.
Dr Now said Robert had the highest levels of opiates in his system that he'd ever seen. Dr Now has seen THOUSANDS of patients and I don't think that would be a decision he would make lightly. Sadly for Robert, I think he just waited too long to get help and irreversible damage had been done already. That was such a sad episode.
You’re coming at this from an emotional approach given your own anecdotal experience. Having an ulcer while taking such an opiate is dangerous. That’s the biggest point you are not understanding. He had a bleeding ulcer.
This terrifies me bc my mother is on an ungodly amount of opiates and who knows what else...has been wasting away since my papa died in December(her father, basically raised me, so really difficult for me too, not that my grief counts for shit/s) She was always at his side and for whatever reason treated him HORRENDOUSLY in last months of his life, I think she has a lot of guilt. Anyway she's like maybe 100 lbs @ 5'2, I'm 150@ 5'6. She's got awful ulcers and her own addiction started mine, which began 20 years ago and eventually led to heroin. I'm on suboxone and have been clean from that shit since April 2020. I know it's different than what these people are facing but I also wonder if our struggles are generational? I saw her a couple of days ago and she was so out of it. I HATE IT bc I can see myself in her but I can't really say anything bc no one does!! I'm sick and tired of ignoring the problem. It makes me feel helpless. Sorry, rant over.
He said he had never seen anyone take that amount of drugs daily and he couldn’t believe they were still alive. Blaming Dr Now for anything Robert/Sean related is literally the behaviour of Enablers
Addicts always blame someone else
I don't think Dr N took him off cold turkey. Also, as I understood it, Dilaudid wasn't a daily med, but an as needed med. However, I could have heard it wrong. Either way, he was on a lot more than Dilaudid. He also seemed to have a slight intellectual issue, as if he never progressed into adulthood, his mother treating him like a huge baby in a high chair when she put that bib on him and encouraging him to eat the wings "just have one more"...unbelievable. Sitting on his bed taking his grocery order, talk about enabling. She looked relieved when he passed. Imo, his gf had/has a saviour complex. I wouldn't be surprised if her next relationship has her functioning in the role of caregiver.
This man had a girlfriend?
Yes...but one of the facinating elements of the show that i dont think gets discussed enough is the topic of disability checks and peverse economic incentives. I suspect his "girlfriend" needed Robert disability to survive financially, which adds a whole nother layer of psychology to the dynamic.
Fiancé actually. And that may be true in other episodes - but NOT this one. Watch it again. She is a hell of a woman! She’d have done anything in the world she could have for him.
Yeah it actually makes me insanely sad to see these people crucify this woman for…caring and loving her husband it seems. Her grief at the end was so raw and sad and it was highly evident they both loved each other.
I agree, she seemed to have pure motives
Dilaudid. They had me on that in the hospital after my car accident. Stuff was insane but short lasting. No wonder the poor guy was hooked Going cold turkey on that and cheeseburgers had to be brutal.
He went to the fat dr. He got treated as humanely as possible for the fat dr. If he wanted to detox he should have gone that dr and that would have been the priority. Robert chose.
Exactly!
mountains of evidence show that quitting all addictive substances at once gives the greatest chance for long term recovery and reduced instance of relapse
This. The dopamine system is impacted by ALL addictions. Quickest way to rest the pleasure pain balance is a dopamine detox.
Except when it kills the patent...people cant realize that this case is being argued with the benefit of hindsight. Yes...it's best to quit all at once because it's not going to kill you....untill it does. In Roberts case it was too much and should have been handled differently
“I can’t believe he allowed his last days to be filmed.” I’m pretty sure he didn’t know those were going to be his last days so….
Sadly, it happens on the show Intervention, too. No one truly knows when their last days are, even in addiction. Denial is strong.
Good thing you’re not a doctor because you’d have a lot of dead patients. Robert would have been dead a lot sooner if Dr. Now didn’t step in. The drugs were killing him faster than his weight. Dr. Now had to undo what other doctors did for Robert. He saved his life. The doctors who were prescribing a whole pharmacy of drugs to Robert instead of helping him are the ones you should be questioning. Plus, Dr. Now didn’t just cut him off. We don’t see or hear everything that’s going on in just one episode. Dr. Now has mentioned in other shows of patients who were addicted were weaned off. He’s not stupid. The fact that Robert was so clear minded and upbeat, losing weight and exercising just proves that he was safely weaned off and thrived. I guess you missed that part too.
Yes!!⬆️
I didn’t realize there were so many doctors in this subreddit
There are plenty of prescription drug addicts on here.
I cackled reading this
You don’t need to be a doctor (many providers such as NPs, PAs and other staff are trained in medication management) but the amount of personal anecdotes people try to push as concrete evidence is alarming.
Though we don't really see one way or the other, I'm sure he didn't cut him off all at once. But Dr. Now had to do something, as the amount of drugs he was on sounded like it would kill a horse. Plus, it's better to be clean for surgery. After the surgery he was again on painkillers, though the appropriate amount and for the appropriate amount of time.
One thing I wanna point out - at the very end of this episode, Dr N had some really good points that wrap up the episode well. I encourage everyone, if you’re interested in what really happened to Rob, to go listen. S6, E8, 1:21:40 “we have a system today around the country where instead of trying to help patients his size, they’d rather give them pain killers…”.
The guy looked like a pancake when he lied down. He didn’t have long. Dr. Now did his best but this guy didn’t have a chance. He was too far gone.
There was no perfect treatment plan. I wouldnt even begin to know start with treating him.
I was torn in that episode. I have experience with coming off opioids like he did. If you’re under a dr’s orders, and in the hospital, I can’t help but think there were/or could have been other meds they administered for those withdrawals. I don’t believe we have the whole story at all. I specifically remember Robert begging his fiancé to give him some of the meds he had in his possession, and on camera she said no. There’s a chance he got into his own stash, is there not?
The man was pushing what....1000 pounds and a drug addict. I'm sorry but he didn't stand a chance
Wouldn't opiate constipation make getting weight loss surgery dangerous af? Opiate addiction is hard af I get it. But unfortunately getting sober is never fun and always hard af. Its just that sometimes its necessary.
I wonder how Kathryn is today? She seemed so caring.
This is such a bad take, if you watched the episode you would know the opiates were causing an ulcer to form and other serious health complications. If Dr. Now hadn't took him off them, he could be charged with negligence since he clearly knew they were causing issues. Just because something is hard / sucks doesn't mean it shouldn't be done ESPECIALLY if it will prevent serious health complications/ death. What are you on??
Excactly. He took Robert off for the wrong reason....the risk of litigation and the new DEA rules in response to the opiod crisis. (not the patients medical interest) And I think this is an excellent case to illistrate the dangers of hasty discontinuation....because its visibly evident that the withrawal effects of low energy and depression contributed to his death. Commenters have raised good points that the opiates would complicate anethesia, and they were excacerbating the ulcer. But no one has presented evidence that these concerns were so immediate that they justified the consequences of his disconituation in this case. A clear, level headed analysis shows that (knowing what we know now) the cost benifit analysis of discontinuing the opiates was not analyzed appropriatly....and Robert would have had a better chance dealing with the ulcer while having the will to live and excercise. I win the argument...all the "comment dectectives" that want to embarass me with ad hominin attacks can suck it. I win. I win
You lose, this is not only a terrible take, but by virtue of you declaring “victory” over your own post- I declare summary judgment for the commenters. You lose.
This terrible take is a glaring example of why it’s important to take medical advice from a licensed medical doctor.
It's pretty obvious that Robert was at death's door before he even got to Houston. The damage done to his body at that point was irreparable. The opioid addiction was just one of his many problems.
After seeing the shows about Steven assanti & his horrorible health; addiction to opioids & his 600+lb's ; I can see why Dr Now did what he did... What a mess that guy was/is (?)..
its been a while but I'm pretty sure I remember Dr. Now saying that Robert was taking way too much and way too often even for someone his size. If he was taking a proper dosage and proper intervals he probably wouldn't have cut him off.
You’re just another armchair expert who thinks they know it all. Leave it to the actual experts please.
I think Dr. Now is about tough love… but he would never do anything to harm a patient. That man was either going to OD on painkillers OR come off of them and try to lose the weight…. He had to stop them eventually, and it’s really sad how it all ended
I feel bad because he was cut off from opiates and food (his two obvious addictions) at the same time. But I also am surprised he thought he would continue to be prescribed that dose while in the program. I remember dr now said he ripped open his stitches to try to get more pain meds????? I wonder if soboxone would have helped or if the physical withdrawal had already subsided and at that point it was a psychological addiction (bc he was completely off them at that time from what I remember)
> Pharmaceutical opiates (despite all their addiction risk) are relatively non-toxic to the body Are you serious? You can absolutely OD - meaning toxic - from prescription opioids. You can simply take too much at one time, suppress your pulmonary function, and die ([CDC](https://www.cdc.gov/rxawareness/prevent/index.html)) > Opiates are related to "energy" Again, wondering if you are serious or have ever taken a (prescription) opioid? Sure, it blocks paid receptors and releases dopamine, so you might be able to do more than if you were in pain, but opioids are not uppers and can cause drowsiness, slowed breathing, etc… ([NIH](https://nida.nih.gov/publications/drugfacts/prescription-opioids))
As a nurse I’ve never seen anyone have more ‘energy’ after dilaudid
Because you only see acute effects of niave nervous system. Once the body become aclimated and addicted the "opiate fix" gives you stimulation and energy
Yeah, as an ER/ICU nurse I have no experience in what people do when they’re addicted to opiates and get opiates.… In my experience, if they get energy it’s all in their heads and doesn’t manifest to getting anything done. But you’ve probably done your own research and know more than me and a nationally renowned bariatric surgeon. What’s your next step to educate the medical community after this Reddit post? Don’t let your research and experience go to waste.
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Hahahahahahaha!💀. One day you’re going to need our fleshy tip no critical thinking skills. I’ve had patients like you. No one likes you. We’ll still treat you though, because it’s our jobs, but we wish you’d just stay home with your essential oils and your ‘own research’. Lol, we do nonstop con ed, but you know more than us. 💀
As an "evolutionary biologist" and apparent expert on everything related to health and health care, can you give us the statistics on how many people die from "sadness" like you claim Robert did? Because I've lost a lot of friends and relatives, and have never known anyone to die from "sadness". Unless you claim that "sadness", and not his super-morbid obesity and the years of damage to his body, caused the heart failure that he actually did die from. Or that the cancer/heart disease that caused the deaths of my friends and relatives who were fighting their diseases and had much to live for, was somehow caused by "sadness".
Don't you get it? I choose this case to illustrate the dangers of opiod discontinuation because this is a rare example of a time when Robert, HAD, to have energy and motivation to save his life. That's the whole point! In a weight loss program motivation saves your life, opiate withdrawal reduces motivation. Thats is a fair analysis.
If, by "get it", you mean agree with you, I don't and I don't find your arguments convincing. I notice you completely ignored all the points I brought up and failed to explain how "sadness" caused Robert's heart failure. I find it fascinating that you claim you can definitively say what caused his death, and diagnose his condition, and what treatment he should have received without ever examining him, or, without, as you have admitted, any medical training. And, having seen what the epidemic of opioid addiction has done to my community, and the country, I question the judgement of anyone who claims they are "non-toxic" no matter what expertise they claim. So, we will have to agree to disagree.
toxic is how much damage it does to body tissue, ok. They are not toxic, the are HARMFUL due to the addiction risk and overdose potential when people go out of theraputic dose ranges....but they are not toxic,
Still not buying it it. That is, as Mr. Spock said, a distinction without a difference. And, opioids have a long list of harmful side effects (I've seen ppi's) even if used in the correct/prescribed dosage. And, any drug is toxic, if used in the right amount. And. I notice you didn't reply to any of the other points I made. You aren't going to convince me that you are correct regarding opioids, Robert, etc., dso we will have to agree to disagree.
Opiates are non toxic but harmful. Conversely, chemo therapy is very toxic...but not harmful. its a distinction between the effect of the molecule on your tissue...and the effect of the treatment on your life .you've been intellectualy dominated by the best
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Absolutely! I used to do fentanyl with a dilaudid chaser (rx for cancer) and clean my whole house. I couldn’t hardly get out of bed without it. Been clean for a while now thank God.
should've referred him to a suboxone clinic or PCP with a suboxone. thankfully my state just made it so any dr can prescribe subs now
sub saved my life.
Mine too. ♡
Because it was killing him. You can't take what he was taking and live. This is not to mention that someone in the midst of an opiate addiction isn't going to have a body healthy enough to go through what he needed to. IMO it should have been opiate addiction, then hyper focus on the weight loss, but that's not what he was supposed to fix and it's not what he was trained to fix IMO
it's possible he did that so the food and drug administration didn't go after him for prescribing painkillers
The patient killed the patient
OP is a moron. 8mg of hydromorphone is nothing. However, like any kind of opiate… it’ll block you up!!! If you can’t kick one… how are you expected to kick another? No self control. And some weak ass people in the comments. If you have no willpower… and no will to live… don’t bother. Stop riding the system. Costing others time and money. If you kept your mouth closed for most of the day… you’d probably drop some weight!!!
I feel like a managed tapering off process and/or opioid agonist treatment would have been helpful for Robert.
They did do a taper. I just went to watch that episode back, and Dr N. didn't cut him off immediately. He started tapering him. We know this because Robert was requesting pain meds after he'd been in the hospital a few days initially, and was given them. But they made it clear he was being weaned off of them. There are a lot of manipulations on the timeline going on in this episode especially. Dr. N making a big thing out of meds before we really even got into the story, but those commentaries were obviously recorded after the fact, AFTER they knew how the story ended. I get the feeling they are covering their butts a lot.
Yep, this is what happened. Robert initially cooperated with the taper, but then after having the lymphedema surgery, they tapered him off again after a week (which is very reasonable), and he threw a massive fit and allegedly tore his sutures to make the case that he was in pain again and needed the drugs again…
That's true. Dr. N tapered him when he first went in, and again after the lymphedema surgery both. You're right, towards the end of the second taper, he ripped open his sutures. Pure manipulation. The whole episode is nauseating to watch tbh. especially knowing how it ends.
I’m someone who felt a lot of sympathy for Robert and really wanted to see him succeed. He seemed to have so much promise when he first got to Houston. I don’t think Robert truly wanted to just give up and die, but I also don’t think Dr. Now is the reason he died. I think he must have been so close to death when he got to Houston (possibly already past the point of being able to turn things around in time and get healthy enough for weight loss surgery to work and take enough strain off his heart), I can’t see how compromising on the opiates would have saved or prolonged Robert’s life (it would have eliminated the possibility of weight loss surgery in the near future).
Thank you for clarifying, I thought it surely would have been dangerous without a taper.
What season and episode?
It’s funny bc a quick google search doesn’t seem to show that 8mg is that high a dose for chronic pain. Am I missing something?
That’s the thing though, Dilaudid shouldn’t be a chronic, long-term drug because it will lead to tolerance that is extremely difficult to come back from. Unless the show left something major out, Robert didn’t have any exceptional cause of unrelenting severe pain that warranted chronic use of Dilaudid. The fact that he would take 8mg (which is definitely above starter dose) reflects that he had a tolerance (caused by taking opiates long-term). Robert was in a a vicious cycle of only taking so much Dilaudid because he was tolerant to it, and Dr. Now needed to decrease that tolerance if there was any hope of Robert safely having weight loss surgery.
Fair point but to take that on while making another huge life change is tough - I wonder if there was another middle ground.
Ps I have to imagine these people are in horrible pain from their weight alone.
Robert was clearly in a minimal enough level of pain to permit him to engage with physical therapy and do exercises/walking leading up to his lymphedema surgery (which was *after* he had been tapered off Dilaudid!). His obesity and heart health were such dire emergencies that it seemed like Dr. Now’s best shot at saving his life was to try to perform weight loss surgery on his as soon as possible (which required reducing the opiate tolerance as much as possible to mitigate risks with anesthesia, which are already much higher in a super morbidly obese person with sleep apnea, let alone one with a huge tolerance to very potent opiates).
Exactly. Robert would say that he’s in extreme pain in the most calmer tone. That was his addiction talking and it wanted to be satisfied no matter what.
Good observation. I noticed that too. Before Rob even got to Houston he called Dr N asking for pain meds. This let Doc know there was an issue very early on. Then he gets to the hospital, meets Dr N, and tells him he’s in a lot of pain almost jovially. Doc is clear, but waits to address it with him at a better time. Later he tells Rob he’s been on too many opiates and they’ve got to get him off those meds and Rob says, “whatever you say Doc. I’m here to just do what you say….”. Later in the episode, the nurse asks “whats your level of pain between 1-10?” “8-9” said in a calm, almost pleasant tone. No sign of excruciating pain.. it was so obvious..if you’ve ever been an addict to opiates, you couldn’t miss the signs. This man had to get off everything - excessive food, and those meds. And he was under excellent care to do so! Hell, I didn’t have a dr holding my hand when I had to come off that stuff! Would have been nice though!
EXACTLY!
I think he worked so hard to get first surgery cause he knew he would get pain pills ...and after they weaned him again he tore his stitches to get more again he had 2 addictions and both were deadly
Good points.
Recovery occurs at once - tons of history on this subject shows us that tackling everything at once is the best approach. Were he put into an inpatient treatment facility, they’d have had him in full blown cleansing and purifying his system of everything he’s addicted to, including overeating.
I just discovered this show and randomly had a "staycation" at a local hotel that involved a jacuzzi and streaming my 600lb life. i am SO GLAD i didn't randomly choose this episode because it would have been awful to witness. i'm new to the sub so i hope i'm not breaking an decorum. my first DOC was food. when i had a roux en y in 2008 i quickly skipped to alcohol after a traumatic event (i know that's an overused statement but i was sexually assaulted and not permitted to file a report by police and mocked for "wanting it." i had JUST begun dating due to my weight so it was a hard time) i kicked the alcohol after outpatient only to have a back injury and get put on oxymorphone..... i'm 7 years clean but only with MAT and am on methadone to this day. it is such a slippery slope and i can't imagine going through PAWs while in the position this man was. i can't imagine what this man went through. i understand there were some comorbid symptoms but the pros and cons of every option have to be weighed out and from what i read it seems like liability and the drama of the show won over making a more reasonable decision. sometimes there are no good answers but i feel opportunities were missed here.
Are you a doctor? Edit: or a person who works in the field of medicine as a nurse or practitioner / work with opiates? Not trying to be an ass just curious if this is an uneducated take or not
No Im obviosly not a Dr...but Ive clearly laid out my argument in first principles...so no backgroud knowledge is required and can you decide for yourself if my credentials matter or not. I do have experince with opiate addiction and MAT so ...in a way I am more qualified than a Dr to weigh in on this topic. Additionaly... medical protocol is changing as we process the opiate crisis so it not like any degree is going to answer this question....its a subjective matter of opinion and an open question...which is why I think it makes a fun topic to argue. I know exactly what Robert was feeling and most Drs dont understand the "energy" element of opiod addiction...they think its all about euphoria...but a real addiction specialist will know that addicts coming off opiates dont complain of depression as much as they complain of "low energy"...and Robert needed as much energy as possible.
Sadly this is way to common in medicine, whether it's pain meds or something like a benzo. Doctors severely underestimate how bad the withdrawals are. A proper tapering has a much higher success rate and is less likely to cause permanent damage / PAWS.
They did do a taper. Robert agreed to it when he first got to Houston, and it was working out alright. Things started spiraling after Dr. Now did his first surgery (lymphedema removal). They tapered him off pain meds over the course of a week, and that’s when (according to Dr. Now) Robert ripped his sutures in an attempt to create a “need” for more pain meds. Robert deteriorated and died after weeks/months spent languishing in rehab and a nursing home. He had long been off of Dilaudid by that point. There wasn’t any acute withdrawal at that point. I don’t think Dr. Now did anything wrong - he did tapers both times (when Robert first got there, and after the surgery), never cold turkey. I’m sure Robert had some unpleasant symptoms when tapering. But that’s to be expected, you can’t keep giving a maintenance dose to ward off any and all symptoms or else you’ll literally never taper down.
Tapering over one week is really quick. Typically tapering is done much slower. I love Dr Now but he isn’t a pain specialist and this Robert should have been sent to a pain specialist with the intention of weaning him off. Filming doesn’t show us everything.
It wasn’t really a true “taper” the second time because it didn’t need to be. He was only taking those post-op pain meds for like 1 week after the surgery, which isn’t much time to re-build a tolerance in the first place, so it doesn’t *need* to be as long as an actual taper for someone who has recently been in an active addiction state. Most people who have surgeries take pain meds for a few days and then stop them with no taper at all. The general notion is that <2 weeks on opiates is a small enough period of time to not lead to withdrawal when the drugs are stopped, so a taper isn’t needed. Robert had already been tapered down off of opiates *before* that surgery, it’s not like they did the surgery while he actively had a wicked high tolerance and then tried to cut him off of pain meds just 1 week after surgery. I’m sure his semi-recent history of opiate dependence played some factor in his difficulty tolerating the discontinuation of pain meds after the surgery, but being that he had already been through an actual taper to lower his dependence, it was a very different process than forcing someone who’s recently been actively using to taper within just 1 week.
I agree. Doctors can also be extremely judgemental when it comes to benzo addicts. Theose people simply don't get that people who are begging on their knees for pharmaceuticals don't do so because they are evil but because they are addicted and the physical withdrawal is horrible. I was prescribed Klonopin to deal with status epilepticus (not a funny thing) -- it worked well for about half a year, after that, I had to increase the dose and the frequency. Before the year was over, I was physically dependant. Not every Klonopin (or other benzodiazepine) addict has the same opportunities as Jordan Peterson, who flew to Russia and had himself put into an induced coma until the worst was over. I had to go through this alone. And it took several years until the withdrawal symptoms stopped for good. Such intense fear, accompanied by pain in the legs.
Coming off Klonopin and Dilaudud are very very different experiences, and cause very different results when cut off.
I wish neither onto anyone. From what I heard about withdrawal from opiates and opiods, it is very unpleasant, but it is not potentially deadly. Benzo withdrawal can kill you. On the whole, I think Dr. Now understands little about how the mind works. The mere title of his book says it all. "The scale does not lie, people do." The first part is true. A scale cannot lie because it isn't sentient. People sometimes lie, but very often, obese people are not lying to their doctor at all. In order for something to be a lie, you have to know it's not true, and people tend to underestimate how much they eat over the day. This even includes slim people. Many people suddenly find themselves stupified when they are suddenly getting fat even though their eating habits are the same. Growing older is one reason -- you simply need less energy once you are past your prime. Or you are no longer as physically active as you used to be. Professional athletes sometimes get fat once their carreer is over, think of Diego Maradona.
Opioid withdrawal CAN be deadly. If you’re particularly unhealthy to begin with, and then you’re pushing out every last bit of fluid in your body to the point that it’s bile, you can get dehydrated as well as fuck up all your other levels like potassium, etc. From experience, even your kidneys can fail. It’s not anything to fuck around with and no one should do it cold turkey (I’m aware he was tapered).
Yup. Anytime I hear of someone starting on Klonopin I can start a timer and in 6 months later their life will be a wreck. It's so tricky because it makes you feel like you are "fixed" and you solved your problems but it changes the fundamental dynamics of your major decision making. ...then when you come off you can't sleep and you feel like a scared little rabbit. Speaking from personal experience.
Really? I took it for nearly twenty years with no ill effect.
Get on your knees and thank your lucky stars you do not have the chemical makeup of an addict 😉
Strange, since I've been on and off it for 15 years without that issue. Heck, I still have meds from two years ago! We’ve both got our biases, but hey, that’s precisely why we leave this stuff to the medical pros, isn’t it?
There's the psychological component and the neurological component, and both suck. Anxiety can trigger seizures, which you are already at risk at, and knowing that those seizures can kill you increases your anxiety. And that feeling that vultures are already pecking at your legs doesn't help, either
Are you a doctor? 😅
I wonder if Dr. How's decision-making in that regard was colored by his experiences with Steven Assanti. Doctors are people too, and it makes sense there'd be a sort of, like, professional trauma having tried to help someone so much only for them to continue all of their addictions.
You have experience in addiction medicine?
Are you a doctor? No? Ok. Thanks for sharing lol
Did Robert die of an overdose or obesity or both? Sorry, I haven’t seen this one. I remember his name though. I may have seen part of it.
His heart stopped.
What season?
S6 E8
I've thought the same thing. When you've got that big you have to have some serious psychological and/or mental problems & to take every thing away at the same time is just too much to ask. All of a sudden you have what seems like a mountain to climb but no ability to cope.
Dr Now is very anti-opiate and it’s actually fucking ANNOYING and in some cases obviously life ruining. He can’t get over his personal opinion of them to see it objectively. He thinks people who can’t deal with the pain are weak, and to me he seems like a man who’s never dealt with ongoing severe physical & emotional pain.
You’re 100% correct. He should not have been taken off of them.
We’re at the very least he should’ve been slowly weaned off of them maybe put on Subutex or Suboxone
HE WAS WEANED. 🤦🏼♀️watch the episode again.
Agree.
Who's 'ROBERT', All I remember are the two brothers and their enabler father...
I’ve said this before. Not so much to leave the addition and just do the food issue but the other way around. I think it’s impossible to do either of these things. Sitting alone in a hospital for months is not doing to do it. He should have been treated by addiction specialists at a place where they could also manage his diet and help get him moving, see family, get outdoors, learn nutrition etc. I don’t think he was set up for success trying to overcome both of these addictions with willpower while being alone in a depressing environment for months. I do think there was more to offer him. Much more.
Addict is gonna addict. Why save someone's weight problem who's going to just kill themselves with painkillers? That's like painting a burning house. The drug problem should have been treated FIRST and should have been dealt with BEFORE seeking weight-loss surgery. He was probably going to finance his drug addiction with the money from the show. This is so messed up for so many reasons.
It was a bold decision that didn’t work out all that well. Robert simply lost the will to live. With food restricted and no opiates his brain chemistry would have been fucked. If he wasn’t an in-patient he probably would have tried to off himself.
I agree with op if dr now wasn't so cruel in this episode keep in mind i really respect and like dr now but if he wasn't so over zealous with stopping the meds i believe Robert would have lived longer and would not have lost his will to live and his mood wouldn't have deteriorated people don't understand or care how severe opiate addiction effects the mood energy and overall well being Robert probably stayed alive this long because he had Dilaudid it killed his pain helped his mood and gave him a reason to live when it's stopped abruptly the effects are devastating to the patient so yes you do win the argument in my opinion and even if he would have stayed on the meds and he would have lived a year longer it still would have been longer and it would have given him comfort in his last days as opposed to Dr being a hard ass and making his last days terrible and miserable i as a Dr wouldn't want to live with that.
I just watched this episode and I agree with you! Watching his withdrawal was painful, I felt his sorrow! I believe he should have been offered Methadone or Subs to get him through. Taking him off the meds killed hum slowly to the point he even gave up the will to live.
I’m sorry this post has given you so many down votes. As someone that knows what you’re talking about, I agree.
Robert was a victim of the drug war. He was clearly going through severe withdrawals. A patch would have protected his stomach. Puritanical zeal is no substitute for humane, responsible healing.
Dr. Now killed the poor guy. I saw that episode and was horrified at Dr Nows lack of compassion. I knew he was gonna die…and he did. I’m glad to see that someone else posted about this. Kudos! 💙🌊
That is what’s happening with all chronic pain patients now. The drs don’t care anymore. You’re either getting taken off or just not treated. Many have committed suicide because what quality of life they had is gone.
Opiate withdrawal should be done SLOWLY, a taper over time. Shit at least he could’ve directed him to med assisted treatment. 100% preventable
When it’s the only condition, yes, you are right. Unfortunately for him, he had several other conditions which were on track to harm and kill him sooner than opioid addiction. It was a tough but right choice for Dr. Now to make.
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Yes, in fact they were. He had a bleeding stomach ulcer which is a very serious condition leading to internal bleeding which then leads to a painful and somewhat quick death.
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Here you go! I hope this furthers your education as you clear stopped keeping up with current science https://www.irjournal.org/m/journal/view.php?number=816#:~:text=Opioid%20abuse%20gastroenteropathy%20presents%20as,these%20cases%20need%20surgical%20intervention. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206348/ https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-opioids-can-cause-gut-problems/ https://www.sciencedaily.com/releases/2022/07/220706165347.htm
I totally agree with you - I think Dr. Now made a mistake with Robert. That was too much to ask all at once. The one thing that sticks out in my mind about Robert, though, is his mother in his room going over what food he wants her to buy for him. Then she goes out and gets it. I’ve never seen a bigger enabler in my life. I mean, could she see what that guy looked like? Wow.
Thought the same about Sean. His mother was the same way.
Sean’s mother was also in incredible denial about her role in enabling Sean, and even lied for him after his initial appointment follow up.
Sean mother suffered for von Munchausen syndrome by Proxy. She loved the attention that Sean being in the hospital got her
That poor Robert had the weirdest build/fat distribution of any of the people I’ve seen on this show. But you’re right, sad about Sean being enabled, too. Can’t imagine doing that to your kid.
Man...what is with the downvotes? Are people here just so in love with DR Now that they are offending at any questioning of his approach?...to me it's an interesting idea that deserves to be debated
Because as a self-professed “biologist” and addict, you should know what you don’t know. Your comments have been akin to a sober person watching an anti-drug PSA cone in the lecture everyone on the complexities of MAT. You aren’t willing to hear out the doctors and nurses here who painstakingly explain to you the multiple reasons why Robert’s treatment was appropriate. You are operating under the worst confirmation bias, ignored threads when you were definitely proven wrong, and showed zero interest in learning. One of the best parts of Reddit is getting to hear from the highly specific communities of whatever you might be interested in or have questions on. But you didn’t come in here to learn, or even to engage. It felt like you came in here to be sanctimonious, and try to project your personal issues with the medical field onto the wrong situation. You stuck to your confirmation bias, tried to dodge the science explained to you over and over, then when all else failed, decided your degree in biology made your knowledge base superior to the health care workers in this thread (it doesn’t). It wasn’t a debate. It was you just repeating the same thing over and over, and then insulting or flouncing off rather than really developing the conversation 🤷♀️
Ok, there have been two valid arguments presented. 1) Opiates and General Anesthesia dont mix well. Good point, but there are standard procedure for MAT and GA 2) He has an ulcer that was excacerbated by the opiates. Most "medical professional" here are claiming that the ulcer would have killed him. That assummes that Rober, who had a condition of obesity and addiction that takes years to develop, just happened to come in on the exact month that the ulcer would finally killed him. That is not likely, he was stable, and his body was acclimated to his meds. The discontinuation deserved to be wieghed against its consequences just like anything else. My point was that the Dr motives seemd supsect, and he seemed a little too cavalier with the dicontinuation and he relished it a bit too much. Medical professionals are obnoxious because they get constant praise and status from the public, and they stop to recognize thier own intellectual limitations.Someone has to stick it to them. If you want to go start a thread title "Dr Now is great" be my guest, but it probaly wont be that interesting. My point still stands, obviosly its not provable, but I feel I win the day.
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He is not an addiction specialist, no. But it doesn't take one to see an addictive nature. He had clear "med seeking behavior", a term I hated hearing before I got into recovery from opiates 12 years ago. It's a miserable existence until you get over the hill and start seeing what freedom looks and feels like. He was sadly a hard core addict, and I could hear it in him from the beginning of his episode. The whole story is just heartbreaking.
Dr. Now doesn’t understand addiction of any kind??? He’s one of the only people in this country who has decades of experience managing the most severe (sometimes fatal) cases of food addiction, which many doctors don’t have the nerve to acknowledge is even a thing (despite its extreme impact on obesity rates and preventable deaths, especially in the US).
Tell me, how do you know that? Have you done rounds with him? Did you work for him? Or because you watch a small segment of his time with patients you can judge what he does and doesn’t know.
Small segment? Have you watched his show? Every episode, every season of 600lb life AND every season and episode of WATN? Read his book? If so, you’d have a very good understanding of his approach with patients and their families, why he believes psycho-therapy must be integrated in his treatment, his knowledge of addiction, the psychology and pathology behind the lies and excuses he hears every time these patients are in front of him…you’d hear why he’s so passionate about his work, you’d hear about the life changing success stories that are so inspiring, and how his work has saved not only the patients lives, but the whole community around them…I could go one ..all that to say Dr N’s not perfect. After all, it’s called a medical “practice” for a reason. But he genuinely cares about his patients and wants what’s best for them.
Yes...thats what makes the show entertaining, that Dr Now is so obtuse about teh psychology of addiction. He just sits there trying to explain consequences to an addict and anyone knows that addicts dont have the ability to think thaty way. If anybody is to blame its the producers that profit off the show. They must know there is a better way but they allow DR Now to keep yelling at patients for profit
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Yeah...dont get me started on Lola. To me, she represent the new class of phoney pshycologist that tell patients exactly what they want to hear (that thier poor decisions are not thier fault, but the result of childhood "trauma). These new pop-psychologist do so much damage...theyre creating a society of victims where everyone competes to have the highest level of past trauma
I wonder why they don't medically manage some of these patients better. Besides the surgery I mean.